The importance of normoglycemia in critically ill patients.

Hyperglycemia is a risk factor for adverse outcomes in acutely ill patients with and without diabetes. One third of all patients admitted to tertiary care facilities have hyperglycemia, with approximately 12% having had no prior history of diabetes. Hyperglycemia adversely affects fluid balance, predisposes to infection, morbidity following acute cardiovascular events, and increases the risk for renal failure, polyneuropathy, and mortality in ICU patients. Because traditional thought suggests hypoglycemia presents a more serious risk to critically ill patients than does hyperglycemia, clinicians are often less than aggressive in treating blood glucoses under 200 mg/dl. Current research, however, demonstrates that even modest degrees of hyperglycemia are associated with adverse outcomes in critically ill patients. Safe implementation of normoglycemia in intensive care patients can be labor intensive and requires well-formulated treatment strategies and interdisciplinary support. Therefore, understanding the importance of intensive glucose control, being comfortable with current clinical treatment modalities, and having the necessary resources to provide this type of care, are vital to critical care nursing practice today.